Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 002628 | OH |
NPI | 1003079161 |
---|---|
Provider Name | Mrs. Lillian Marie Mcnultyl |
First Address | Highland Heights, OH 44143-3114 |
Second Address | Ashtabula, OH 44004-6930 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2008 |
Last Update Date | 08/07/2008 |